| NPI | 1063793214 |
|---|---|
| Doing Business As | CREEKSIDE FAMILY PRACTICE |
| Entity Type | Organization |
| Authorized Contact | TAMI RAZNOFF CFO 239-658-3137 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Enumeration Date | 2011-09-01 |
| Last Update Date | 2019-07-03 |